Hakan Aylanç

Early detection of myocardial deformation by 2D speckle tracking echocardiography in normotensive obese children and adolescents

Objective: To evaluate the left venticular myocardial deformation parameters in normotensive obese children and adolescents by using 2-D speckle tracking echocardiography. Methods: This observational cross-sectional study included 69 children and adolescents (aged between 10-18), 38 were normotensive obese and 31 were normal weighted. All children underwent detailed two- dimentional, Doppler and two-dimentional speckle tracking echocardiography. Student t-test, Mann-Whitney U test, chi-square test and Pearson’s correlation were used in statistical analysis. Multiple linear regression analysis was used the determine independent variables on global longitudinal strain (GLS). Results: While in normal limits, diastolic blood pressure was significantly higher in obese group. Left ventricular end-diastolic diameter (LVDd) and end-systolic diameter (LVDs), interventricular septal thickness (IVSd), left ventricular posterior wall thickness (LPWD) and left ventricular mass index (LVM)/height2.7 were significantly higher in obese group compared to healthy peers (p=0.004, p=0.011, p<0.001, p=0.001, p<0.001) respectively. Obese subjects had reduced global longitudinal strain (GLS) values (p=0.001). Multiple linear regression analysis using the step-wise method were performed to assess the independent variables (age, body mass index, insulin resistance, systolic blood pressure, diastolic blood pressure, left ventricular diameters and LVM index (g/m2.7) affecting the dependent variable GLS. GLS was found significantly correlated with body mass index (BMI) (β:0.440, p:0.001; 95% CI: 0.104-0.311). Conclusion: Left ventricular strain parameters obtained by two dimentional speckle tracking echocardiography were diminished in obese children compared to normal subjects indicating that obesity in childhood is linked to decreased myocardial deformation even in the absence of comorbidities in early stages.

Does intrauterine tobacco exposure increase the pain perception of newborns

Background This study aimed to assess whether there was a difference in the pain-perception levels of newborns born to mothers who smoked during pregnancy and newborns born to mothers who were not exposed to active or passive smoking during pregnancy. Materials and methods A total of 60 newborns born by normal spontaneous vaginal birth between June 2013 and June 2014 were included in the study: 30 born to mothers who smoked during pregnancy, and 30 born to mothers not exposed to smoking. Mothers or newborns who had taken analgesics or sedative medications in the previous 24 hours, newborns not born at term, and sick newborns were not included in the study. During the routine hepatitis B-vaccination injection given at postnatal 48 hours, the newborns’ behavior was monitored and recorded by video camera. The data obtained from the recordings were evaluated according to the Neonatal Pain, Agitation, and Sedation Scale and analyzed with SPSS 20. Results The median pain score of the group exposed to tobacco smoke in utero was 8.5, while the median pain score of the unexposed group was 6 (P<0.001). Conclusion Exposure to tobacco smoke in utero may increase the pain-perception levels of newborns.

Relationship between Abdominal Aortic Intima Media Thickness and Central Obesity in Children

Background: Childhood obesity is one of the important risk factors for early atherosclerosis. We aimed to evaluate the effect of obesity on abdominal aortic intima media thickness (aaIMT) in children. Methods: We consecutively recruited 60 obese and 28 healthy children from the outpatient clinic of pediatrics. In all patients, BMI, waist circumference (WC) and hip circumference (HC) were measured, and fasting serum lipid profile, plasma glucose and plasma insulin were studied. Homeostasis model assessment-estimated insulin resistance (HOMA-IR) was calculated for the obese group. All children underwent ultrasonography to evaluate hepatosteatosis and to measure aaIMT. Results: There was a significant difference between the groups in terms of aaIMT, insulin, glucose, HOMA-IR, total cholesterol, low-density lipoprotein, triglyceride and hepatosteatosis. aaIMT was 1.12 ± 0.25 and 0.61 ± 0.18 mm in the obese and nonobese groups, respectively (p < 0.001). In the obese group, there was a positive correlation between aaIMT and WC, WC/height ratio, BMI, HC and hepatosteatosis (p < 0.05 for all), with the highest significance for WC. Conclusions: This study showed that aaIMT was significantly higher in obese children than in nonobese children, and that WC was a strong predictor for aaIMT. Early detection of an increased aaIMT in obese children may guide the follow-up of these patients in terms of developing atherosclerosis and its complications.

Relation between QT Variables and Left Ventricular Geometry in Athletes and Obese Children

INTRODUCTION We aimed to evaluate the relation between QT variables and left ventricular geometry in athletes and obese children. MATERIAL AND METHODS This study included 209 children and adolescents. Thirty-eight of them were obese, 140 were athletes and 31 were normal weighted. Children with history of functional and structural cardiovascular diseases (acquired and congenital), chronic systemic diseases, hypertension, sleep apnea, endocrinological disorders were excluded. All subjects underwent detailed electrocardiographic and echocardiographic examination. RESULTS QT dispersion was significantly higher in obese children, basketball players, football players and swimmers compared to control group (p < 0.05, p < 0.001, < 0.001 and < 0.01 respectively). Basketball players had the highest QT dispersion. Left ventricular endsystolic diameter (mm/m2) was higher in footballers, swimmers, wrestlers and tennis players compared to obese subjects. Interventricular septal thickness at diastole was highest in swimmers compared to control group (p < 0.001) and left ventricular posterior wall thickness was significantly higher in footballers and swimmers compared to healthy subjects (p < 0.01 and p < 0.001 respectively). Left ventricular geometry was normal in 84 patients (47.1%), but 34 patients (19.1%) had concentric remodelling, 20 (22.4%) had concentric hypertrophy and 40 (28.6%) had eccentric hypertrophy. No concentric and eccentric hypertrophy was observed in obese subjects. Left ventricle hypertrophy was prominent in dynamic and combined groups but it was not statistically significant (p = 0.204). QT dispersion was statistically higher in obese, dynamic sports and combined sports compared to control group (p < 0.05, p < 0.001 and p < 0.001 respectively). DISCUSSION In this study we determined that QT dispersion is elevated in dynamic and combined sports types and obese children. CONCLUSION QT dispersion is prolonged in obese and athletes who participate dynamic and combined sports.

Benign Acute Childhood Myositis due to Toxoplasmosis

To the Editor : A previously healthy 5-y-old boy was admitted to the emergency department with the complaint of leg pain and refusal to walk. Ten days ago he had a period of low-grade fever and fatigue that recovered spontaneously. Twenty-four hours before the admission the leg pain began and then he refused to walk. He was living in a village and had a history of contact with cats. On physical examination, he was well, afebrile and other vital signs were within normal limits. There was no lymphadenopathy or hepatosplenomegaly. Neurologic examination was normal. Extremity examination revealed bilateral calf tenderness on palpation. His gait was stiff-legged and flat-footed; he had difficulty in walking. Complete blood count and basic metabolic profile were normal. Creatine kinase (CK) increased to 809 U/L, three times normal (26–308 U/L). Urinalysis was normal and negative for myoglobin. Serology was performed to establish the etiology. It supported the acute toxoplasma infection and no other agent. His serologic results for T.gondii were as following; IgG Dye test was 6000 (positive ≥16), IgM ELISA was 10 (positive ≥2) and IgG avidity was 1.8 (low ≤20). He completely recovered and could walk independently on the 5th day of follow up. His CK returned to normal (126 U/L) and was diagnosed as benign childhood acute myositis (BCAM) after a toxoplasma infection. Benign childhood acute myositisis is a muscle syndrome that is most commonly seen after a viral infection [1]. The most common presentation of the disease is acute refusal to walk or altered gait during walking. Although the most common etiologic agents are influenza type A and B viruses, the other agents are also reported in the literature [2, 3]. Toxoplasmosis is mostly subclinical or asymptomatic infectious disease in healthy children. Myocarditis and myositis are reported as rare clinical findings [4]. The other clinical findings of BCAM are male predominance and serum CK increase. If the CK levels are too high, patient should be monitored in terms of rhabdomyolysis and renal failure [5]. Duration of symptoms are short and the recovery is spontaneous; therefore, further investigations are unnecessary unless the diagnosis is suspected [3]. In patients with acute gait disturbances if there are no alarming symptoms, BCAM should be considered certainly before unnecessary and invasive investigations. Viral serologic investigations are helpful in supporting the diagnosis.

The MEFV gene pathogenic variants and phenotype-genotype correlation in children with familial Mediterranean fever in the Çanakkale population

Abstract The aim of the current study was to determine the frequency of the Mediterranean fever (MEFV) gene pathogenic variants in 60 children diagnosed with familial Mediterranean fever (FMF) and to compare the phenotype-genotype correlation. Genomic DNA was isolated by the spin-column method from peripheral blood samples (collected in vacutainers containing EDTA) and buccal smears. The MEFV gene profiles for the current FMF cohort were genotyped by pyrosequencing and direct Sanger sequencing techniques for the target pathogenic variants. The most prominent clinical symptoms were abdominal pain (53.4%), fever (23.4%) and arthritis (23.3%). Eighteen different pathogenic variants were identified and the most frequent were p.Met694Val (20.0%), p.Glu148Gln (13.3%), p.Met680 Ile (11.7%) and p.Arg202Gln (11.7%). Abdominal pain, fever and arthritis were the most common presenting clinical characteristics. Results showed that not only clinical characteristics, but also genotyping of the MEFV gene is needed to establish the correct diagnosis of FMF in children and other family members.

The Effects of Passive Smoking on the Six-Minute Walk Test in Obese Pediatric Cases

Objective: The aim of this study was to evaluate whether exposure to second-hand smoke affected the six-minute walk test (6MWT) of obese non-asthmatic pediatric cases. Methods: Obese pediatric patients (body mass index >95th p) with no existing co-morbidities were included in the study. Smoke exposure was assessed with a self-reported questionnaire completed by the parents. The subjects were divided into two groups: Group 1 consisting of obese children exposed to passive smoking and Group 2 of obese children not exposed to passive smoking. In addition to 6MWT, spirometric flow and volume, including forced expiratory volume in 1 s and peak expiratory flow rate, were also measured in all subjects. The results of the 6MWT were assessed to determine any association with passive smoking. Results: The study included 75 obese pediatric cases (40 male, 35 female) with a mean age of 9.06±0.97 years. The 6MWT results in Group 1 was 501.88±62.12 meters and in Group 2 559.63±72.93 meters. The difference was statistically significant (p=0.001). Conclusions: Passive smoking may negatively affect the respiratory and cardiovascular capacity in obese children, who are already at risk of lower cardiopulmonary function. The evaluation of 6MWT in these pediatric patients may be useful for monitoring and families should be warned about potential problems due to smoking.

Investigation of Blood Betatrophin Levels in Obese Children with Non-Alcoholic Fatty Liver Disease

Purpose The prevalence of obesity has significantly increased among children and adolescents worldwide and is becoming an important health care problem in parallel with the increased prevalence of obesity pediatric non-alcoholic fatty liver disease. Betatrophin is a newly define hormone that is commonly secreted by liver and plays role in glucose tolerance. This study aimed to investigate the relationship between serum betatrophin levels and non-alcoholic fatty liver disease in obese children. Methods The study included 40 obese children with a body mass index (BMI) above 95th centile, and 35 non-obese subjects with a BMI 3-85th centile, whose age and gender were similar to those of the patient group. For the evaluation of metabolic parameters fasting serum glucose, insulin, alanine aminotransferase, aspartate aminotransferase, lipid profile and serum betatrophin levels were measured. Total cholesterol: high-density lipoprotein cholesterol and low-density lipoprotein cholesterol: high-density lipoprotein cholesterol ratios were calculated as “atherogenic indices.” Results Serum betatrophin levels of the obese subjects were similar to that of non-obese subjects (p=0.90). Betatrophin levels were not correlated with the metabolic parameters. Conclusion In the present study, levels of betatrophin are not different between obese and insulin resistant children and non-obese subjects, and they are not correlated with atherogenic indices. To elucidate the exact role of betatrophin in obesity, further studies are required to identify the betatrophin receptor and/or other possible cofactors.

Influence of body mass index on mindfulness awareness and coping methods for stress in adolescents.

Abstract Objective: Psychological state may affect the body weight through the hypothalamus and vice versa. The goal of this study is to investigate whether body mass index affect mindfulness awareness (MA) levels and type of coping with stress. Methods: Healthy adolescents were included in the study. The mindfulness attention awareness scale (MAAS), indicating the ways of coping checklist inventory was performed and body mass index (BMI) (kg/m2) of adolescents were calculated. The influence of BMI on MA and ways of coping with stress was tested. According to BMI percentiles the study population was grouped as obese (including overweight), normal-weighted and underweight. Results: A total of 270 adolescents (mean age: 13.63±2.07 years; 165 female/105 male) participated in the study. No significant correlation was found between BMI and MA scores (r=−0.085; p=0.161) and coping strategies were not different between the groups. When MA scores are compared with stress coping methods, it appeares that participants with high awareness levels chose positive coping styles. Conclusion: BMI is not effective on MA levels and choice of stress coping methods. But the higher MA levels are associated with positive coping styles.

The prevalence of thyroid nodules in children with family history for nodular goiter

Introduction: There is insufficient study on the genetic clustering of nodular goiter. Although twin studies have proved genetic clustering, there is no prospective study on this topic. The aim of this study is to investigate the existence of familial clustering by evaluating the prevalence of thyroid nodules in the children of families with nodular goiter.Methods: The prevalence of thyroid nodules was calculated by evaluating the thyroid ultrasound results of children from families with and without nodular goiter.Results: Nodular goiter was detected in 5 children (3.4%), 2 (2.5%) from families with nodular goiter history and 3 (4.7%) from the control group. There was no statistically significant difference between these two groups.Conclusions: This is the first prospective study to investigate the familial aspect of nodular goiter disease. In our study, children with nodular goiter were the target group. Following statistical analysis, clustering of nodular goiter was observed in the children of patients with multinodular goiter.